Michael Gerson: The ideological state of the union

For President Obama, the state of the political union ... could be better.

It is not only that the president’s political support is diminished; it is diminished in large part because of his main political achievement. Because of the way the Affordable Care Act was sold — “you can keep your plan” — Americans have questions about Obama’s credibility. Because of the way it has been implemented, they have questions about his competence. In a recent Quinnipiac poll, a plurality of American voters doubt Obama is “honest and trustworthy” and a majority believe the Obama administration is not competent.

Add to this an economy recovering so weakly and inequitably that 77 percent of voters call it “not so good” or “poor” and you have a serious possibility the president’s party will lose control of the Senate in November.

The great rhetorical problem for Obama is that these are not primarily rhetorical problems. It is neither fair nor realistic to ask speechwriters to succeed where legislators, bureaucrats and health economists have made a botch of it.

This political situation would be interesting if it were not so boring. A second-term president faces declining public standing and a tough midterm election. Not much news there.

It is the ideological state of the union that is less typical and more alarming.

The unraveling of Obamacare is also an unfolding crisis for liberalism. It was the universal liberal assumption that offering fairly generous health benefits to the uninsured would result in many more of them actually becoming insured, thus creating a social expectation that Republicans could never repeal. (This was also the fear of tea party conservatives.)

But a large majority of the 2.2 million people who had purchased insurance on the exchanges by year-end — 65 percent to 90 percent, according to reporting by The Wall Street Journal — already had insurance. Economic writer Megan McArdle does the math, estimating that just 15 percent (750,000) of the 5 million uninsured that the Congressional Budget Office expected to sign up in the first year have actually done so.

Economists debate the reasons for this but, as it stands, Obamacare is largely a health insurance replacement system, not so much an expansion. And the replacement is often less generous, more expensive and more restricted in options than promised. Yet, as McArdle points out, “the worst is yet to come”: small-business policy cancellations, expensive government subsidies to insurance companies for excess losses, higher premiums in the exchanges, the IRS collection of individual mandate penalties.

As the defining legislative promise of modern liberalism is implemented, trust in government is near record lows. And this complicates every other element of the progressive agenda.

Meanwhile, Republicans argue internally — not only about what policy alternatives they might offer but about whether federal policy on most issues is legitimate. And the ideological position generally taken to be more authentically conservative is also unresponsive to public needs and alienating to public opinion. The tea party argument in favor of narrowly interpreted, specifically enumerated constitutional powers is not only a criticism of Obamacare but calls into question the legitimacy of the Great Society and New Deal as well.

This is not, in fact, the more “authentic” conservative tradition, which has stronger ties to the Federalists and Lincoln than to the anti-Federalists. But this view has come to characterize a significant portion of conservative activists. And given the choice between incompetent liberalism and tea party populism, Americas are, well, in deep trouble.

The alternative is a reform-oriented conservatism that makes peace with the safety net, while empowering individuals and rejecting bureaucratic centralization — the spirit, for example, of the Patient CARE Act, an alternative to Obamacare recently introduced by Republican Sens. Tom Coburn, Richard Burr and Orrin Hatch. It represents what the union needs most right now: another ideological option.

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It's unraveling because all the problems they were warned about by people who actually read and made SOME kind of sense of that mess (before those who DIDN'T read it shoved it down our throats) are surfacing.

50+ years of tossing garbage into a pot to simmer (just waiting for the perfect time to force-feed us) is bound to make a foul stew.

American Heritage Dictionary definition of fascism: "...a system of government that exercises a dictatorship of the extreme right, typically through the merging of state and business leadership, together with belligerent nationalism."

back in 2009, instead of what is now the ACA that they essentially invented as an alternative to Hillarycare back in the 1990s?

Now we have to go through the process of vetting this new alternative which, I think, has something to do with tax-incentives. We haven't heard enough about it to even know how it's supposed to work "better" than Romney/Obamacare.

We should have gone with the public option. As it is, it is not clear if these present systems will bring down the outrageous costs of health care and pharma in the USA. I recently heard about a case where a man with cancer was paying $17K for a bottle of pills that cost $300 to make.